Orthopedics

By Tiffany Lai September 1, 2023

If you’re a new therapist, orthopedics is a great place to start. For the most part, bones are straightforward and predictable.

Charting

For this service, it is important to pay special attention to:

  • Precautions
  • Weightbearing status
  • Hemoglobin and hematocrit levels
  • Pain

Treatment

Give special attention to premedication for pain. Pain medications should be administered 30 min to 1 hour before therapy.

Check orthostatic blood pressure readings, SPO2, and heart rate.

Visualize the location of the incision. This might tip you off to missed precautions in the chart.

Treatment is early mobility to patients tolerance and ADLs.

Ice packs help with pain and swelling after or during the treatment session. Icing too long can be detrimental unless the patient has a cold therapy machine. The general rule is 20 min on and 20 min off.

Precautions

Hip surgery Anterior (incision in lateral anterior hip)

  • Precautions: No hip extension, crossing legs, external rotation, WBAT

Hip surgery Posterior (incision at posterior lateral hip)

  • Precautions: No hip flexion past 90, crossing legs, internal rotation, WBAT
  • Sock aide and reacher for LB dressing, elevated commode

Total hip arthroplasty (THA)

  • Weightbearing precautions - usually WBAT

Knee surgery

  • Precautions - usually WBAT
  • ROM for knee flexion and extension

Shoulder arthroplasty

  • Precautions - usually NWB, sling
  • Adaptive dressing techniques
  • Sling management

Humerus/radial nail

  • Precautions - sling

Trauma

  • Check for weightbearing precautions at sites of fracture and that they’re cleared to mobilize
  • Make sure team has checked the cervical, thoracic, lumbar spine for fracture before mobilization
  • Cognitive screen

Spine

Evaluation/Treatment

  • Sensation - numbness, tingling, dermatome patterns
  • Check strength of affected limbs
  • Spasticity

Precautions:

Cervical

  • May have a C collar or halo brace
  • No turning or bending neck, or shoulder flexion above 90

Thoracic

  • Spinal Precautions
  • TLSO

Lumbar

  • Spinal Precautions
  • LSO

Sacral

  • No hip flexion past 90, hip abduction or external rotation

Tip: Cervical or Lumbar drains must be clamped before mobilization

Ray Amputations (foot)

  • Weightbearing status
  • Orders for offloading shoe

Ribs

  • Generally, no precautions
  • Common in patients needing CPR
  • Premedicate for pain

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